Root Cause Analysis: Education Reform Needed

It’s not easy. Sure. But it must be done.

Somehow. Some way.

Three topics emerged as important patient safety concepts during the first two days in Telluride: (1) Communication; (2) Teamwork; and, (3) Root Cause Analysis.

Of course, teamwork relies on effective communication, so the two are intertwined. In clinical medicine, doctors and nurses communicate constantly as part of patient care teams. However, many patient safety issues arise from poor communication and the resulting ineffective teamwork between doctors and nurses. Why do doctors and nurses communicate poorly? In part, this barrier to teamwork begins during medical and nursing training. Nurses and doctors start training in silos during nursing school and medical school. Social psychology research shows that separating any group of people creates cultural barriers spontaneously, needlessly. This dynamic plays out in healthcare: our clinicians train in isolation and then are expected to work together cohesively as clinicians during their careers. This educational problem creates long-term divides.

In patient safety work, “root cause analyses” are performed to identify how medical errors occurred. By identifying the step in the process that is problematic, solutions can be engineered to create a system that remedy these conditions susceptible to mishaps. A root cause analysis of the communication problems between doctors and nurses reveals that how we train clinicians in the United States healthcare system is problematic. Somehow, some way, medical and nursing (and other allied health professional) students must train together early on and in meaningful ways to build effective teamwork skills for their future careers. Undoubtedly, it is challenging to find ways to integrate the curricula at these separate schools, but it must be done.

Luckily, leaders at medical and nursing schools around the country (several of them are here this week in Telluride!) recognize this reality and are working on creative solutions. For instance, at Johns Hopkins, I helped co-found the Doctor-Nurse Alliance (DNA):

http://magazine.nursing.jhu.edu/2012/04/from-silos-to-synergy/

Doctor-Nurse Aligned (DNA) teamwork forms the complimentary, double-stranded backbone of patient care.

This past year, DNA organized social, service, and training activities for students at the Johns Hopkins School of Medicine and School of Nursing. One activity that students enjoy and find valuable is DNA Interprofessional Shadowing: a medical student and a nursing student pair up and then spend half of an afternoon shadowing nurses together and then the second half shadowing physicians together. This interdisciplinary experience helps break down cultural barriers by creating a shared understanding between students at both schools.

From these efforts, student leaders at both schools got involved with faculty in reforming the curricula. As a result of faculty and students working together creatively, next year, Hopkins medical and nursing students will enjoy four required training activities together as part of their standard curricula. One of these sessions focuses on patient safety. At the conclusion of each of these events, food will be provided so that students from both schools can socialize together.

Going forward, I hope that more medical and nursing (and other allied health professional) schools will create meaningful shared training experiences for students so that foundations for effective communication and teamwork can be established early on, leading to safer patient care in the long-run.

It’s not easy. Sure. But it must be done.

Somehow. Someway.

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